Spine Care

Our approach to treatment focuses on a quick return to activities through rehabilitation. For patients with spinal disorders that require surgical correction, we offer state-of-the-art procedures and equipment. Drs. Cory R. Gaiser and James McLoughlin serve as our spine specialists.


Fractures of the Thoracic and Lumbar Spine

A spinal fracture is a serious injury.

The most common fractures of the spine occur in the thoracic (midback) and lumbar spine (lower back) or at the connection of the two (thoracolumbar junction). These fractures are typically caused by high-velocity accidents, such as a car crash or fall from height.

Men experience fractures of the thoracic or lumbar spine four times more often than women. Seniors are also at risk for these fractures, due to weakened bone from osteoporosis.

Because of the energy required to cause these spinal fractures, patients often have additional injuries that require treatment. The spinal cord may be injured, depending on the severity of the spinal fracture.

Dr. Gaiser holding spine

Cause

Fractures of the thoracic and lumbar spine are usually caused by high-energy trauma, such as:

  • Car crash
  • Fall from height
  • Sports accident
  • Violent act, such as a gunshot wound 

Spinal fractures are not always caused by trauma. For example, people with osteoporosis, tumors, or other underlying conditions that weaken bone can fracture a vertebra during normal, daily activities.

Types of Spinal Fractures

A compression fracture of the lumbar (lower) spine.

There are different types of spinal fractures. Doctors classify fractures of the thoracic and lumbar spine based upon pattern of injury and whether there is a spinal cord injury. Classifying the fracture patterns can help to determine the proper treatment. The three major types of spine fracture patterns are flexion, extension, and rotation.

Flexion Fracture Pattern

Compression fracture. While the front (anterior) of the vertebra breaks and loses height, the back (posterior) part of it does not. This type of fracture is usually stable and rarely associated with neurologic problems.

Axial Burst Fracture

The vertebra loses height on both the front and back sides. It is often caused by a fall from a height and landing on the feet.

Extension Fracture Pattern

Flexion/distraction (Chance) fracture. The vertebra is literally pulled apart (distraction). This can happen in accidents such as a head-on car crash, in which the upper body is thrown forward while the pelvis is stabilized by a lap seat belt.

Rotation Fracture Pattern

Transverse process fracture. This fracture is uncommon and results from rotation or extreme sideways (lateral) bending, and usually does not affect stability.

Fracture-dislocation.

This is an unstable injury involving bone and/or soft tissue in which a vertebra may move off an adjacent vertebra (displaced). These injuries frequently cause serious spinal cord compression.

A side-view of a fracture-dislocation of a thoracic vertebra.
 
A magnetic resonance imaging (MRI) scan of a fracture-dislocation in the thoracic spine. Note the disruption of the spinal cord.

Neck Pain

The neck (cervical spine) is composed of vertebrae that begin in the upper torso and end at the base of the skull. The bony vertebrae along with the ligaments (which are comparable to thick rubber bands) provide stability to the spine. The muscles allow for support and motion. The neck has a significant amount of motion and supports the weight of the head. However, because it is less protected than the rest of the spine, the neck can be vulnerable to injury and disorders that produce pain and restrict motion. For many people, neck pain is a temporary condition that disappears with time. Others need medical diagnosis and treatment to relieve their symptoms.

Cause

Neck pain may result from abnormalities in the soft tissues—the muscles, ligaments, and nerves—as well as in bones and joints of the spine. The most common causes of neck pain are soft-tissue abnormalities due to injury or prolonged wear and tear. In rare instances, infection or tumors may cause neck pain. In some people, neck problems may be the source of pain in the upper back, shoulders, or arms.

Inflammatory Diseases

The vertebral column.

Rheumatoid arthritis can destroy joints in the neck and cause severe stiffness and pain. Rheumatoid arthritis typically occurs in the upper neck area. 

Cervical Disk Degeneration (Spondylosis)

The disk acts as a shock absorber between the bones in the neck. In cervical disk degeneration (which typically occurs in people age 40 years and older), the normal gelatin-like center of the disk degenerates and the space between the vertebrae narrows. As the disk space narrows, added stress is applied to the joints of the spine causing further wear and degenerative disease. The cervical disk may also protrude and put pressure on the spinal cord or nerve roots when the rim of the disk weakens. This is known as a herniated cervical disk. 

Injury

Because the neck is so flexible and because it supports the head, it is extremely vulnerable to injury. Motor vehicle or diving accidents, contact sports, and falls may result in neck injury. The regular use of safety belts in motor vehicles can help to prevent or minimize neck injury. A "rear end" automobile collision may result in hyperextension, a backward motion of the neck beyond normal limits, or hyperflexion, a forward motion of the neck beyond normal limits. The most common neck injuries involve the soft tissues: the muscles and ligaments. Severe neck injuries with a fracture or dislocation of the neck may damage the spinal cord and cause paralysis. 

Other Causes

Less common causes of neck pain include tumors, infections, or congenital abnormalities of the vertebrae.

When Should You Seek Medical Care?

If severe neck pain occurs following an injury (motor vehicle accident, diving accident, or fall), a trained professional, such as a paramedic, should immobilize the patient to avoid the risk of further injury and possible paralysis. Medical care should be sought immediately.

Immediate medical care should also be sought when an injury causes pain in the neck that radiates down the arms and legs.
Radiating pain or numbness in your arms or legs causing weakness in the arms or legs without significant neck pain should also be evaluated.
If there has not been an injury, you should seek medical care when neck pain is:

  • continuous and persistent
  • severe
  • accompanied by pain that radiates down the arms or legs
  • accompanied by headaches, numbness, tingling, or weakness

Many patients seek orthopaedic care for neck pain because orthopaedists are specifically trained to diagnose, treat, and help prevent problems involving the muscles, bones, joints, ligaments, and tendons. Although some orthopaedists confine their practices to specific areas of the musculoskeletal system, most treat a wide variety of diseases, injuries, and other conditions, including neck pain.

A special Thank You to the American Academy of Orthopaedic Surgeons for the above article.